Readers' clinic: knee pain

Our team of experts responds to readers' heath queries.

Knee pain has a number of causes

7:00AM BST 29 Mar 2010

Dear Readers’ Clinic

I am 45 and have been suffering from pain at the back of my left knee. It started mid-afternoon on the first day of a skiing holiday, although no obvious trauma caused it. I’d been aware for months of tightness in my left calf and have long suffered from right-sided hip pain brought on by a traffic accident when I was younger. A friend says my knee pain may be a result of my body compensating for my hip pain. Is this right?

Mr P T, Lancashire

Osteopath Kristian Wood replies:

Dear Mr P T

There are several causes of posterior knee pain, and skiing may trigger a few of them. Often, these injuries are traumatic in onset but yours was not. Therefore, I want to address the “compensatory theory”, and explain how it might have played out. From the history you’ve given, it is clear you would have subconsciously adopted a posture aimed at reducing the strain throughout your body caused by the compromised hip. The most obvious strategy is to off-load the weight-bearing function of your “bad” hip on to your “good” hip.

But standing primarily on one leg has its consequences. The supporting limb has to absorb an abnormal amount of load and this is done with the leg locked out at the knee. A huge amount of pressure is displaced towards the back of the knee – the knee has to hyper-extend. Over time, the muscles, tendons, and ligaments become strained and susceptible to injury.

One of the muscles that operates over the knee joint is the calf (gastrocnemius) muscle. The tightness you felt before the injury may have been a sign that the muscle was struggling to cope. It would be overworking, having to combine its normal functions with that of reinforcing the posterior aspect of the knee. Then the muscle becomes overstretched as the knee over-extends. It may be that skiing was a stress too far. I suspect the pain is the result of tendonitis involving one of the hamstring muscles, but this would only be confirmed through a thorough assessment. I recommend that you see an osteopath or physiotherapist, and address the problems with your posture and movement – and increase your body’s capacity to cope.